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Do Alcoholics Deserve Liver Transplants?

This story is making the rounds again. It reveals a lot about how society thinks of alcoholics.

Here is an example from the latest incarnation of the story from the UK. Eunice Booker, whose 26-year-old daughter died in a car crash in 2006, is quoted by the UK's Observer newspaper as saying: "I find it offensive that one in four of the livers donated go to alcoholics. If there are two people side by side wanting a liver, and both have the right tissue match, and one is an alcoholic and one isn't, there's no contest - you take the one who's not an alcoholic, they are more entitled."

This "entitlement" issue is at the heart of the controversy. One of the previous occasions this story came up was when the soccer legend George Best was given a liver transplant in 2002 after battling with alcoholism for all his adult life. After receiving his liver transplant, he was seen out drinking more than once. He had been warned repeatedly that drinking would kill him, even after his transplant. He died three years later. Here is a quote about Best's transplant from a reader of the Daily Mail, a British tabloid newspaper.

"George Best's liver transplant was morally indefensible. A viable liver was wasted on him. There are not enough livers available for transplant to people with non-alcoholic related diseases, people who are ill through no fault of their own".

Here we have "fault" as well as entitlement. Somehow alcoholics are at fault for becoming alcoholics. Almost everyone drinks or smokes at some point in their lives, but the majority of people do not develop problems and this seems to make it harder for them to understand those that do. This issue is exacerbated by the heavy drinking culture of the UK (George Best once said "I spent a lot of money on booze, women and fast cars. The rest I just squandered").

Alcoholics, like all addicts, are usually diagnosed once their drug use has become a problem. It has become a problem because they are suffering from the defining symptom of addiction; loss of control. In fact the very definition of an addiction is "continued drug use in spite of adverse consequences". George Best is a classic example. Here is a man who has been told, like so many alcoholics, that his drinking has ruined his liver function to the point where he needs major surgery. If he carries on drinking, he will die. So what does he do? He goes drinking. I'd say death was an adverse consequence. Is there any more direct example of the loss of control that defines an addiction?

The public understanding of addiction lags behind that of other mental disorders. Telling an alcoholic to "stop drinking" is like telling a victim of depression to "cheer up" or an anxiety sufferer to "calm down". In the past few decades, great progress has been made in recognizing diseases like depression, anxiety and posttraumatic stress disorder for what they are; medical conditions deserving of sympathy and treatment. We still have a long way to go with addiction.

"Here we have "fault" as well as entitlement. Somehow alcoholics are at fault for becoming alcoholics."

You failed to explain how alcoholics are NOT at fault for their condition. I have not heard of anyone who was tied to a chair and had alcohol poured down their throat until they became dependant. It always starts with a person CHOOSING of their own free will to drink.

"Almost everyone drinks or smokes at some point in their lives, but the majority of people do not develop problems and this seems to make it harder for them to understand those that do." This issue is exacerbated by the heavy drinking culture of the UK (George Best once said "I spent a lot of money on booze, women and fast cars. The rest I just squandered")."

You seem to refute your own argument, as this statement suggests the only difference between alcoholics and other drinkers is that alcoholics just don't quit. Again, they are not FORCED to drink, they have the strong desire to drink, and satisifying it is more important to them than anything else.

"In fact the very definition of an addiction is "continued drug use in spite of adverse consequences"."

This can applied to a lot things besides alcohol and drugs. People can be addicted to gambling, video games, overeating, pornography, just about anything that is a source of immediate pleasure. And it can happen to ANYONE who overindulges.

"Telling an alcoholic to "stop drinking" is like telling a victim of depression to "cheer up" or an anxiety sufferer to "calm down"."

But that is the goal for curing addiction, is it not? To stop the addictive behavior.

What mainly concerns me about what you wrote is that you imply that addicts are not responsible for their behavior. I have yet to read a self-help book that says "If you are addicted, you are not responsible for your behavior and everyone else should accomodate you." Rather, they say, "If you are addicted, you should GET HELP." Taking care of yourself is your own responsibility first. If you shirk that responsibility, where do you get the right to make others pay for it?

Should we be compassionate to addicts? Of course. We should be willing to help them overcome their trials, but if they are not willing to help themselves, there is nothing the rest of us can do. A new liver did not help George Best. Because he didn't stop drinking, he died anyway. He bought onlythree years of time, when another person could have lived much, much longer. Why should that person suffer for George Best? Why is it better to give one person who gave up on themselves three years life, than to give another person an entire lifetimee to live?

1. Alcoholics suffer from a disease that destroys their liver.
2. Almost everyone drinks at some point. Only some, around 15%, develop a problem.
3. We all choose to start drinking. No-one chooses to become an alcoholic.

People don’t set out to become alcoholic and they can have no way of knowing when they start drinking whether or not they will become an alcoholic. If the simple act of beginning to drink is enough to suggest that people have somehow chosen a path to alcoholism and are thus undeserving of a liver transplant, then most of the population of the western world is not deserving of a liver transplant.

The definition of any addiction is that the patient has lost control over that to which they have become addicted. Yes, this can include things like gambling. Lives are ruined by gambling addiction just as they are by alcohol addiction.

Many alcoholics will tell you they are completely aware of the need to stop drinking, they know full well that their drinking is killing them and ruining the lives of their families and friends. Yet they CAN’T stop. Even though they desperately, desperately want to. This is the defining symptom of addiction. I know this is very hard to understand for people who have not suffered from an addiction.

Simple overindulgence is not a cause of addiction. Plenty of people drink vast amounts for years. Then they stop. They get too old for partying, or they have other interests and responsibilities. Alcoholics can’t stop, whether they want to or not.

You wrote ”What mainly concerns me about what you wrote is that you imply that addicts are not responsible for their behavior. I have yet to read a self-help book that says "If you are addicted, you are not responsible for your behavior and everyone else should accomodate you." Rather, they say, "If you are addicted, you should GET HELP." Taking care of yourself is your own responsibility first. If you shirk that responsibility, where do you get the right to make others pay for it?”

I am sorry if it sounds like addicts should not be expected to take responsibility for their behavior. This was not my intention. They are suffering from a disease just like depression. In the case of addiction, the inability to take care of themselves is one of the symptoms of their disease. If they were able to take care of themselves by quitting drinking, then they would no longer be suffering from a disease. The very thing that society wants addicts to do is the very thing they cannot do. That IS their disease. Of course they should be helped and treated as you say. That treatment often requires a new liver.

I agree that alcoholism is a disease, but I wouldn't say that a new liver is often the "treatment." Also, I think whether an alcoholic is derserving of a liver transplant depends on records of how much the person has been trying to get help.

You might be interested in knowing, that at least for me and for other people I have talked to who have cirrohsis of the liver due to alcohol, that you are not eligible for a new liver unless you are enrolled in a treatment program to document sobriety. You have to have at least six months sobriety to even be considered. They do not give out livers as treatment for alcohols. And it is understood that to be eligible for a new liver you will not ever drink again. I am sure some do. But if you were thought to be a risk I doubt seriously you would be the one to get the liver.

You might be interested in knowing, that at least for me and for other people I have talked to who have cirrohsis of the liver due to alcohol, that you are not eligible for a new liver unless you are enrolled in a treatment program to document sobriety. You have to have at least six months sobriety to even be considered. They do not give out livers as treatment for alcohols. And it is understood that to be eligible for a new liver you will not ever drink again. I am sure some do. But if you were thought to be a risk I doubt seriously you would be the one to get the liver.

I know someone that received a liver transplant and he drank the day before the surgery. After the surgery he continued to drink thus damaging the new liver. He is currently on the liver transplant list again. This is not fair to others that would truly appreciate this gift and would do anything to make this surgery a success. And what about the donors that think they are really helping someone when the truth is their gift of themselves are waisted.

hmm... I get it, so there shouldn't be a discrimination against alcoholics when choosing liver transplant recipients. by the way I am unclear how the process of allowing someone to receive the transplant works, is it discussed by a committee? and what the are the rules used to determine eligibility?

Well it is a matter of choice of the person who want to give his liver with. I think alcoholics should be given a chance to have a liver transplant as long as he will promise that he will not drink again or sign a waiver that he might get jailed if he will drink again.

My husband has had two liver transplants due to a disease called autoimmune hepatiti. He may need a third one. My husband doesnt have a choice but an alcoholic does. A drink or your life I know what I would choose. Get help stay off the alcohol and dont take a liver away someone who deserves it

How dare all of you, who doubt the viability of giving an alcoholic a new liver??! As a sufferer of Cirrhosis, which Was alcohol-induced, when I was diagnosed, I knew I Had to stop drinking and as an addict, It was the hardest thing I have ever had to do. But stop drinking, I did. Unfortunately, many people Cannot. This kind of argument takes the term 'Addiction' and simply flushes it down the toilet! I do sympathise with your husband, but please, also, consider this.. What about the millions of people with weight-connected problems, with heart problems, due to obesity and bad diet., does that mean these people should not receive hospital treatment, or new organs, because they're addicted to Food?? Wake up!, its so very easy to slam those of us in society who, through no fault of our own are somehow Predisposed to addiction. Terribly unfair, dissappointing, and frankly soul-destroying, to find there Are people out there, who are so narrow-minded concerning this. I pity Them.

Tough subject and ethic issues. I'm an alcoholic and have been sober for years. I began drinking in middle age when my eldest child died. I'm not making excuses for my "choice" to drink or not to drink, but addiction is a valid disease and I hate to see it all become about choice. As a previous tee-totaler, I had no idea what the obsession and cure-all for my grieving would become. I'm profoundly ashamed by my lack of control and alcoholism and would give anything to be able to un-do it but I can't. I don't expect anyone else to understand addiction when they're not previous there themselves and especially when "control" issues are brought up. I have control in most areas of my life, except where alcohol is concerned. To be dismissed as an "out of control" person and non-worthy of mental/physical treatment is troubling to say the least. Having said that, I can very much understand when a person waiting for a transplant to save ones life is going to look at another as less as or more deserving than themselves. Especially when their psychical problems are based upon medical reasons beyond their control like Hepatitis.

Congratulations for being of the drink for so long you should be proud of yourself. I dont know what it would feel like to be an alcoholic and woulod say you worked very hard to stop drinking. but I still say they have a CHOICE and they choose the alcohol. Yes it is an addiction but there is so much help out there if its wanted. Where as if you have AIH there isnt the same type of help.

As soon as we introduce the concept that one person may deserve a transplant more than another person, we are veering off into slippery ethical grounds.

This is the same question that arises around issues of abortion on the grounds of prenatal diagnoses deemed unacceptable to the parents, or complex surgical intervention in penitentiaries. Who deserves to live?

The ethical position is this: Either we all "deserve" transplants, or no one deserves a transplant. Otherwise, you're quantifying the value of one human being's life over another's. Is that right? And who among us is so wise as to be able to make such a decision?

If they had alcoholism in their family, they should already know that it makes it more likely for them to be alcoholics themselves once they drink hence not as deserving with the transplants. Also, I didn't think alcoholism was considered an addiction. Is it not different from a cigarette addiction?

I know of someone who needs a liver transplant because he has cirrosis of the liver. He can't even be put on a list until he completes treatment and is 6 months sober. I think it's completely fair.

It's not that easy for them to quit or it wouldn't be an addiction. I have seen him in so much pain and so sick and he still can't stop drinking. He has tried, but after a couple days the withdrawals and the pain is too much for him to handle he goes and gets another drink.

It may sound crazy to some, but unless you've seen it and lived around it I wouldn't expect you to understand. And if there ever comes a day he decides to quit and get sober I would hope he would have just the same chance to get a liver that anyone else needing one would.

As sick as he is and as much pain as he is in if he could quit Im sure he would. He is just so far sucked into this disease it may be too late for him. But when he drinks it takes away the physical pain and Im sure the emotional pain of what he is going through. He really is a great person, he just can't stop his addiction today.

My ex-husband is an alcholic. Among other things this was the primary cause of our divorce. Our marriage was not enough for him to be able to quit nor were our two young children or his family. This in itself clarifys for me the inability of an addict to quit. Last year he was diagnosed ultimately with liver and kidney failure. Within four days of heing hospitalized he was put at the top of the list for a transplant. He was put on the list at the same time they were determining his eligibility...they did every test imaginable to insure that his body could handle the transplant. They made sure there were no other underlying issues or deseases that would shorten his life. Overall the protocal for this transplant was very thurough except for the fact that all they required to prove 6 months of him being sober were letters from family members confirming that he had been sober...I am sorry but how many mothers could not get a few letters from friends or family members to save their sons life? Personally, I would do ANYTHING for my children! The fact is he drank until the day he was admitted to the hospital and he drank shortly after his release. I don't doubt that this terrible desease has a hold on him but I do know that he is now living a lie and has an organ that someone else died for and many others could have lived with...the lack of doing everything possible to stop this addiction is equal to murder in my opinion...he took someone else' chance to live! None of use have the right to decide who should live and who should die..that is out of our hands - if only there were enough organs for all transplant recipiants but that is not the case! I have lived on the other side of this choice and still find the ethics of this issue very disturbing!

re: "People don’t set out to become alcoholic and they can have no way of knowing when they start drinking whether or not they will become an alcoholic."

Everyone knows BEFORE choosing to smoke, drink, or use drugs that (A)there is the possibility of becoming addicted to the substance and (B) they may become ill as a result of using the substance.

The comparison between an alcoholic and a depressed person isn't apples to apples as the depressed person isn't engaging in a behavior that causes the depression whereas the person engaging in substance abuse is engaging in the behavior that causes death or illness.

I have removed my name from the donor registers list because i don't want an alcoholic to get my liver. I know someone who has had a liver transplant due to alcohol abuse, to date he has refrained from drinking but has substituted it with another addiction, Marijuana. He was told that the toxins in smoking will damage his new liver the same as alcohol did with his old one, plus reduce the effects of his anti-rejection drugs, but he continues regardless. This person has no respect at all for his donor or their family, and without them he would be dead.
I know it is said that alcoholism is an illness/desease, but it is one that comes with a choice, cancer is also an illness/desease but it does'nt come with a choice.
surgeons can remove the alcoholic liver but they can't remove the alcolic head. Anyone who knows about addiction will know that an addict will promise you the world in order to get what they want, so when they need a new liver they will tell the surgeon what he wants to hear and promise him that they will never abuse their new liver. Maybe the reason for the shortage of donors is the same as mine, not wanting an alcoholic to receive there organ.

I stray from ethical constraints. I'm an RN and also a recovering
alcoholic. I've been sober for 24 years. By way of explaining my past not condoning or excusing myself I drank heavily after a severe trauma for three years. My liver is functioning fine. However if it were not, I do not feel I should qualify for a transplant. We chemical/alcohol abusers become rapidly addicted for multiple reasons, genetics, trauma etc. Not all of us, but most are aware of various ways to battle our addiction. For me it is AA. It is not possible for the non-addicted person to relate to an alcohol/addict. My husband of 30 years cannot understand why I must dedicate so much of my time to AA (even now after 24 yrs) to maintain my sobriety. AA has only a 10% rate of longterm success(5yrs or more). The reason we HAVE to remain members in good standing FOREVER.

It's just an opinion, and I'm sure my family would feel differently if I needed a liver transplant. But I feel that it's just the luck of the draw for addictive folks like me. We did the damage, regardless of lacking the same internal control issues as the next guy. In AA,the if you work the program and then relapse it means you didn't work hard enough- and that you JUST WANTED TO DRINK. We DO have a choice. And we give up that right to a new liver when we knowingly pick up that drink. (I might change my mind the day I need a transplant....not yet mastered the "judgment of others" thing!)

When George Best received his new liver a comic magazine ran a joke saying that isn't it marvellous that George Best has a new liver so he can fall off the wagon again. At the time this didn't appear prophetic but in the end it was and what had been achieved? A person died to donate a liver which allowed an alcoholic 3 more years of boozing. And don't come that disease stuff with me or addiction. It takes a good deal to get addicted to alcohol, a few drinks will not do it. Nor is it genetic although some people seem to try to convince you it is. Possibly weakness of mind is genetic. This case in particular smacked of complete irresponsibility and had a liver become available in the second case, the question of "entitlement" would be a very valid one.

Michael. What world do you live in mate? I have no idea of your age, however, the person I am conversing with at this moment has a few things to say to You. -Please understand you are talking about an icon, in relation to the support he played. It is my belief that half of bloody Manchester would have donated their own liver with respect to the enjoyment and pleasure watching this superstar play. If push came to shove with him, let me assure you the establishment? would not let him die without the second liver, so think about this mate, I myself have huge liver problems, what chance do you think I've got of getting a liver transplant?, and who gives You the God-given right to choose..? I had a brilliant friend, he had an Addition to alcohol, at what You may call the highest level (God knows what That is), -didn't seem to keep him back though because not only had he poetry published and art exhibited, (because he always felt that everyday was a school-day).. I wonder if it was the drink that enabled him to qualify with no less than 8 degrees, the main one being Psychiatry! Unfortunately, he has passed away, aged 85, and incidentally that May have been his liver. Lucky for you, if You were put in a situation across the table talking to my learned friend, my belief/assumption would be that You would crawl back into the hole from which you came. Think about it, you probably can't answer anyway..

How many of you feel that a person who is speeding, and gets into a car accident that causes someone to die, deserves the jail time, or at least a loss of their license for a long period of time, that they're likely to get?

So if you speed at all, don't you deserve to lose your license or go to prison, too? Why not? Your actions were identical, you risked the chance of taking a life. Do you deserve less punishment because the risk you took didn't lead to someone's death, even if you did no more than the person who was in the fatal accident did, to stop an accident from occurring?

Oh, wait, it takes a lot of speeding to get into an accident?

If you do the exact same thing as another, and the outcome is different, CHANCE is what led to the outcome.

Fact is, alcoholics didn't know their problems were inevitable, only that they were a risk, at best. Just like someone choosing to exceed the speed limit. They felt the risk was manageable, but many acted in a manner no different than anyone else, up to the point of onset of alcoholism, where they lose control.

If alcoholics don't deserve liver transplants, then neither does anyone who has done anything that risks their own health. Speeders don't deserve organ donations should they crash. Steak eaters don't deserve health insurance. Anyone who makes an impulsive purchase doesn't deserve a mortgage or loan.

People do all kind of things excessively, yet people sit back and say that when something bad happens, it's all someone's fault because either the person took a risk they shouldn't have (even one others have taken), or because they did "too much" of the bad thing.

Nobody can say how many times you have to speed to crash, how many Big Macs you have to eat to get fat, how many chips you have to play to become a gambling addict, or how many drinks you have to have to become an alcoholic.

But if something bad happens, it must be because you did something wrong, or took too much risk. Never mind what risks you yourself took. You just know that if you didn't crash, it's because you're a "good driver" who can "handle the speeding better than the other guys."

I have had non-alcholic auto-immune Cirrhosis since I was 21. The argument everyone drinks is incorrect. The only times I drank were once or twice a year for social occasions. I was a loner and a shy person so I never really went out and didn't enjoy the taste of Alcohol. In fact, at functions when pressured to drink I used to have a coke or dilute a single beer with lemonade. I hated alcohol.I used to avoid social events where there was drinking.

I have an enlarged spleen from Cirrhosis, I've vomited blood due to the condition (twice), I have to have Variceal Endoscopic bandings and I live in constant pain. I would sure love a new start at life and I was very fit, healthy and active before I got sick. I have to take fluid tablets now to remove ascites and I am always in pain. If you know what an enlarged spleen feels like its the most uncomfortable thing ever. I can't have the spleen removed either because its acting as a dam for my blood because my scarred liver will not take the blood.

Ultimatley doctors are going to do what they want. I've given up hoping for a liver. It always seems they go to people who drink because they bump their MELD score (criteria for a transplant) up because the drinking does more damage more quickly than progressive, non-alcholic Cirrhosis.

I have bruises from low platelets, my gums bleed and I feel queasy and exhausted all the time. I just wish people would think about people who don't drink. I don't want to punish alcholics who need livers but it seems non-alcholic patients are always forgotten.

a donated organ is a gift. when we donate money to charity how would we like hearing about the charity managers going on fancy holidays and buying expensive clothes of the donated money? we would feel cheated and robbed in a way. So yes this makes it necessary that someone worthy get hold of a donated organ not someone who squanders and wastes.
Please don't compare depression with addictions. I battled with depression for three long years. not once did I take up any addictions. It is easy to give in to temptations. especially resisting the ones that can kill you will be worth while and not steal away someone else's right to live.

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